Pain in the rib area is not always a sign of an injured rib. In the case of cyclists, it is often a sign of a muscle cramp known as exercise-related transient abdominal pain, or more commonly, stitches. It is a common occurrence in runners, cyclists, swimmers and horseback riders. If the area is bruised, tender to the touch or hurts when you move in a twisting motion, you may have a cracked or broken rib. Consult a doctor if you have any of these symptoms.
Symptoms
The pain that is caused by stitches usually appear under the right rib cage, but can occur on the left side of the body. The level of pain will vary depending on the severity of the cramp. If it is more severe, it is felt as a sharp, severe stabbing pain. If it is more moderate, it can feel like a cramping, aching or pulling sensation. According to a 2000 study conducted at the University of Newcastle in Australia, 32 percent of the cyclists surveyed experienced stitches in the previous year.
Causes
The mechanism that causes stitches is unclear, but it is known to be a cramping of the diaphragm -- the powerful muscle below the lungs that is responsible for controlling breathing. The most prevalent theory as to why the cramp occurs is the organs and intestines that are attached to the diaphragm by tendons and tissue put stress on the diaphragm. Any up and down movement that jars the intestines puts pressure on the diaphragm, leading to a cramp -- a powerful, involuntary contraction of the muscle. The diaphragm cramp then contracts the surrounding muscles in the area of the rib cage.
Prevention
You can take several precautions to avoid stitches. While cycling, focus on your breathing and take deep, even breaths. Avoid overexerting yourself, which can lead to rapid breathing and subsequent cramping. A good way to tell if you are at the proper pace is if you can have a conversation while cycling. Avoid eating too soon before exercising. Drink plenty of fluids to keep yourself hydrated; dehydration causes cramps. Stretch your abdominal muscles before and after exercise. Strengthening your core muscles -- the muscles of the abdomen and back -- can help reduce the likelihood of stitches.
Treatment
If you experience a stitch while riding, slowing your pace or stopping should help alleviate the pain. Grabbing the affected area and gently squeezing it or massaging it can often help relax the muscle and reduce the cramping. If you have stopped completely, focus on taking slow, deep breaths while pushing your belly out when inhaling, and relaxing it when you are exhaling.
Considerations
While stitches are a frequent cause of pain under the rib cage, there may be another underlying issue that is causing the pain. A broken or cracked rib is usually caused by a trauma, and will have other symptoms, but there could be an issue with one of your organs or the ribs themselves, such as inflammation of the surrounding cartilage. If you find that taking the steps for preventing stitches does not help, or if you have the pain around the ribs while you are not cycling, consult a doctor for a diagnosis.
References
- "Medicine in Science and Sports Medicine"; Characteristics and Etiology of Exercise-Related Transient Abdominal Pain; DP Morton et al.; February 2000
- TheStretchingHandbook: Side Stitches and Exercise Related Abdominal Pain; Brad Walker
- MayoClinic.com; Broken Ribs --- Symptoms; March 2011
- "British Journal of Sports Medicine"; Exercise Related Transient Abdominal Pain; Dr. DP Morton, 2003
